NATIONAL HEALTH SERVICE (PRESCRIPTION CHARGES)

I beg to move,
That an humble Address be presented to Her Majesty, praying that the National Health Service (Hospital Charges for Drugs and Appliances) Amendment Regulations, 1956 (S.I., 1956. No. 1744), dated 7th November, 1956, a copy of which was laid before this House on 8th November, be annulled.
We are tonight praying against six Statutory Instruments, all of which embody the same principle. I would remind the House that the six Statutory Instruments come into operation next Saturday, 1st December. They will affect thousands of people in the towns and villages of Britain. Tonight we shall hear contributions from both sides of the House, and I believe that they will reveal that the Regulations are unjust, and, indeed, inhuman.

For the clarification of business, I take it that the right hon. Lady is proposing that on the first Prayer there shall be a discussion covering all the Prayers, and that we shall then divide as we may be advised later.

Yes, Mr. Speaker. As the same principle is embodied in all the Regulations, I thought that would be the best method.

As the Regulations will come into operation on Saturday, and as the imposition of the tax will be felt particularly during the winter months, I ask the Minister to be receptive to our speeches and not have a closed mind. I urge him even at this eleventh hour to reconsider the introduction of the Regulations. What is proposed? It is, in effect, the imposition of a discriminatory tax upon the sick and the infirm, those who, far from deserving any extra—

Will my right hon. Friend give way for just one moment? Will she draw to the attention of the Minister responsible the fact that there is no one from the Treasury upon the Government Front Bench and that on the Government benches there are only about seven hon. Members? Yet the subject which we are debating is a matter of fundamental importance to millions of people in Britain at the present time.

I would remind my hon. Friend that that is not unusual when domestic problems are debated in the House.

I would emphasise that the Government proposals represent a discriminatory tax on the sick and infirm. These people, far from deserving any extra burden, should surely evoke our sympathy and compassion. When I say "tax", surely the Minister will agree that that is a not inaccurate description. He will recall that only last week I asked him why he had not sought the advice of the medical world. By "medical world", I include pharmacists. His answer was that this was a budgetary matter and that precluded him from seeking advice. Therefore, this is a tax which has been imposed in an arbitrary manner completely divorced from social and medical considerations, because those people who could have given the advice which I believe a Minister should seek before he takes a serious step like this were completely ignored.

I watch the Minister when he speaks at the Dispatch Box and listen to every answer he gives to Questions, and I am always conscious of the fact that he has the honour and privilege of presiding over a great welfare service and that he is personally charged to protect and care for the sick and disabled. Yet he has allowed these people to be singled out for this harsh tax. I say that he has betrayed his trust.

I am well aware that this matter must have come before the Cabinet. I know precisely the procedure in a Department when action of this kind has to be taken. Consequently, I say that this only goes to show once more how utterly remote are the lives of the sick and poor from the minds of the Conservative Cabinet. I doubt whether it occurred to one man in the Conservative Cabinet to ask how the chronic sick would fare under these Regulations.

I would also say—I hope my hon. Friends will not think that I am on this occasion praising my own profession overmuch—that it is a tribute to the medical profession that it has made an immediate and widespread protest. It knows that a health service has failed if it cannot dispense humanity. In my opinion, that is surely the first policy for which one should look in a health service.

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I now intend to quote from some of the pronouncements which have been made by the professional organisations in order to show the House that the opposition to the Government's proposals is certainly not limited to the Labour Party. Both town and country doctors—who, in my experience, very rarely support my party—have come forward as champions of the sick against the Minister. We all appreciate that the family doctor and the chemist are near to the heart of the family; they know the circumstances of the family and the little contrivances to which the poor patient has to resort to make both ends meet. These people have strongly criticised the Minister. We must ask the right hon. Gentleman why he has failed to seek their advice.

Let me remind him of what the British Medical Association said last week at a Press conference. It said that the new charges were "financial sanctions on sickness". That is very strong language for the British Medical Association. It also said:
Chronic cases of diabetes, heart disease, asthma, epilepsy, ulcers and anaemia would be taxed unfairly for their illnesses.
It said that this would mean that the man bringing up a large family on a small wage would be put into a new tax class.

It also said that:
… the family of four children might cost as much as £1 a week on prescriptions during ordinary epidemic illnesses.
It said:
One effect of the raised charges might be greater self-medication, which could be a menace to the patient.
All hon. Members know the meaning of self-medication as it was practised in the old days before the National Health Service.

The British Medical Association also said:
… there were two essential items on a prescription and the patient had only one shilling, then the chemist might have to decide which to give. This would be a dangerous state of partial prescription.
Then it said something about composite packs of medical supplies which the Minister said he proposed to introduce to save a shilling or two. It said that this was not the perfect answer and might create wastage. A further
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result could well be a tendency to over-prescribe, which might result in waste and more expense to the Service than ever before.

Let us examine this. Of course, it is quite right. These are the views of people who are literally on the job and who know how these suggestions which the Minister has made work out. It may be that a patient will need only one or two dressings and that if the Minister allows composite packs of four dressings there will be wastage. If I may dare to include you, Mr. Speaker, there is not an hon. Member present who has not in his household a little half bottle of tablets, powders, liniments, or lotions which have been wasted. I was astonished when the Minister told the House last week that he would give doctors permission to over-prescribe. Already there is a wastage which shocks us all but which it is difficult to prevent.

The Minister mentioned a period of three months. Does he not realise that in most little homes there is no such thing as a locked cupboard in which to keep tablets? If a doctor prescribes tablets for three months for a patient, it is dangerous to the whole family. Yet these are the contrivances to which the Minister is having to resort to get out of an exceedingly difficult position.

I want to quote The Lancet, which is a well known and respected medical paper. It said this decision:
… will be welcomed by neither patient nor doctor … given that some further reduction in national spending is required, it is by no means clear why this should be made by the sick consumer rather than the healthy consumer. … More of this new levy will be paid by the average woman than the average man … the average aged person will pay about half as much again as the younger person … will bear more heavily on the family man than the individual wage earner.
As such, it contradicts every measure of social policy by discriminating against dependants. In other words, it points out to the Minister that for the first time in the history of the welfare State children are to be taxed, and sick children at that.

Now I come to the chemist. As far as my experience goes, chemists do not necessarily support the Labour Party. The Secretary of the National Pharmaceutical Union expressed the opinion that the new charges may very well seriously interfere with the pharmacists' relationship with
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the medical profession and the public at large. May I explain to the Minister what that means? In a poor district, when a patient goes for a prescription with two or three items on it and does not have two or three shillings, he will ask the chemist, whom he has probably known for many years, which is the most important. He will ask, "Which do you think I should have and which do you think I should leave out?" The chemist will be put into a very difficult unprofessional position.

The chemist may have known the man, woman or child concerned for many years and may also know the doctor down the road. What is he to do? Is he to superimpose his advice on that of the doctor down the road, or allow the individual to go without his medicine? If he says, "Take this, but not that" the doctor will immediately know. Quite understandably, the relationship between the doctor and chemist will not be as happy as it should be. The pharmacists say that this will make their position with their customers very difficult. Certainly if a pharmacist refuses to do that the customer may well go to another chemist who might be prepared to do as he asks. That is how the scheme will work and those are the things which the Minister would have learned had he sought advice in time.

The letter published in The Times from the director of a pharmaceutical firm should be very carefully borne in mind by all of us. This is the tragic position which he described:
A careful survey of the 'multiple' prescriptions"—
those are the prescriptions which have more than one item—
proves that these are for diabetic, cancer, colostomy, and epileptic patients, in that order.
He has analysed them and found that those are the people. Colostomy is an operation often performed for those people who have cancer of the lower bowel—some of the most tragic patients in the whole country.

I want to emphasise this point. The director of this firm has analysed prescriptions and shown that those are the people who will suffer in that order. He said:
To adopt a system which makes these patients pay nearly the whole of the proposed additional levy is indefensible. It reverses
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the whole theory of health insurance and could be likened to a fire insurance company charging the insurer when he has a fire.
Surely, in view of those considered opinions, the Minister should, at this eleventh hour, reconsider the policy.

He is no doubt about to try to save the situation by telling the House that patients in need may have help from the National Assistance Board. I will not give my views, but I will quote Mr. Davies, the acting-chairman of the General Medical Services Committee, representing 20,000 general practitioners in the Health Service. When he read that the Chancellor and the Minister had said that these people would be able to resort to the National Assistance Board, he said:
But there is still a hard core of people in this country who retain the pride and self-respect that they always had. Many of them would rather suffer or deny themselves treatment than seek public assistance.
A doctor with a practice in Lincolnshire said
the new measure imposed impossible conditions on rural general practitioners who had to collect the money for their prescriptions to patients. I do not think that it will lead to economy if our country doctors are put into the position of tax collectors.
Had the Minister forgotten that? Had he forgotten that doctors in rural areas are far away from chemists and that it is therefore a hardship for people to have to go to the towns to get their medicine dispensed and so doctors in rural areas are generally asked not only to dispense the mixture, but also to take the money from the patient? Just think of the agricultural labourer with a small family going to his doctor, the doctor prescribing for him and then having to have a little wrangle over a few shillings which the doctor had to collect.

In an attempt to reassure the House, the Chancellor and the Minister have said that those who cannot afford these charges will be reimbursed. We want to know on what basis. The Minister has left that a little vague. How have the sick people been reassured? Has the Minister seen the link which has been distributed, the link between himself and the colostomies and the epileptics and the diabetics, the link distributed this week? Was he responsible for it? Has he read it? During the last two days this has been distributed to the doctors of the
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country to put up in their surgeries. It is the most astonishing exhibit that I have ever seen in my life. Has the Minister realised that some item of elastic hosiery has been mentioned 14 times in it? Anybody coming to this country from another planet or another country would think that every individual here wore elastic stockings.

The Minister agrees. Has he read this? It is a most remarkable thing. That is the only link the Minister has between himself and this tragic little army which I have described who crowd the waiting rooms of doctors all over England, Wales and Scotland. This is what the sick person in the waiting room is given to look at. This is what the diabetics, cancers, colostomies, epileptics and heart diseases have to read.

After mentioning elastic stockings about 14 times it simply says:
The National Assistance Board is authorised to assist anyone who can show that his resources are insufficient to meet these charges.
Just think of the people I have mentioned. The National Assistance Board office is not necessarily next door to the doctor's surgery. People suffering from the diseases which I have mentioned have to go to the Assistance Board either on foot or in the crowded transport of today, which we are told will very shortly be more crowded, and then, with the awful depression of a fatal disease upon them—and this is not an exaggeration—explain their circumstances to the Board's officers and ask whether they qualify for reimbursement. Surely the Minister cannot impose this upon the country.

No doubt my hon. Friends will address themselves more fully to this aspect of the case, but I want to ask the Minister not only why he has taxed the chronic sick in order to obtain his £5 million, but why he has ignored another source of income. Why has he ignored another aspect of the drug bill which I have brought to his attention upon other occasions? He has agreed that what I say is right, namely, that there has been
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an over-prescribing of proprietary drugs, and he has given an undertaking that he will make inquiries. As far as I can see he has done nothing. I want to bring this to his notice and tell him that here is a source of his £5 million if he likes to be bold and courageous enough to tackle it.

The cost of drugs is certainly high, and in my opinion this can be attributed to three main causes. First, the cost has risen with everything else. Secondly, the introduction of new and expensive drugs has also raised the drug bill. But the third and most important cause is the increased proportion of proprietary drugs. [HON. MEMBERS: "Hear, hear."] I am very glad that some hon. Members understand the technique of the business.

The proportion of proprietary drugs to all drug preparations is constantly rising, and now stands at 36 per cent. of the drug bill. What is the Minister doing about this? From time to time he sends doctors the miserable little document which I hold in my hand—I suppose that he is familiar with it—known as "Prescribes' Notes". It is a guide to doctors. As far as I can see no other document of any importance reaches the doctors.

I should like to know what else he is doing. There seems to be a sense of defeatism in the Ministry over this question. It cannot control the rising cost of the drug bill, and is now reduced to raising money by taxing the sick. I suggest that one of the major causes of the enormous sums of money spent on drugs is to be found in the pharmaceutical industry itself. Practically all the mixtures, tablets, powders and so on prescribed as British Pharmacopoeia preparations are made by British firms, and I agree that the margin of profit on those mixtures is not big. Therefore, the British pharmaceutical industry recoups itself by the sale of proprietaries.

In recent years there has been an invasion of this country by American firms. Of the total value of proprietaries prescribed under the National Health Service, it is estimated that 65 per cent. come from American firms. These American firms have concentrated on the profitable lines. These astute businessmen, recognising that the British Government have given them a blank cheque to sell here as much as they can, at any price they choose to ask, and to take their
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profits out of the country in dollars, if they so wish, have poured all their resources into capturing this market.

They employ enormous outside sales staffs. Pfizers have over 100 representatives in this country. These firms positively embarrass our general practitioners. Instead of patients coming in, the general practitioner is invaded by a high pressure salesman. He tries to be polite, but there are patients waiting. He does his best to get the salesman out of the room, and generally in a weak moment, he promises to take something. At least, he usually takes the samples in order to get rid of the salesman.

The last time I spoke to the Minister on this matter I felt so incensed about it that I brought my samples with me—a thing which I have never done before in my life—as demonstrating what came to my household in the last post. I brought hundreds of tablets. In fact, these things are an embarrassment in doctors' households. We do not know how to dispose of all these tablets. In my last post there was a beautiful, handsome inhaler. The accompanying literature said that I should apply regarding the refills for this thing in a place in Chicago, or two places in New York. That was in the last post and when I get back tonight on my desk will be at least three more advertisements, possibly with powders or tablets from other drug houses. It so happens that in my home both my husband and myself are subject to this attack.

These firms are constantly introducing new antibiotics, and they try to justify them, as I have already said, by reference to printed articles from the American Press. By high pressure selling the British doctor is persuaded to use these preparations at enormous cost to the Service and even to the detriment of the patient. This year alone magazines have been sent free to 22,000 doctors—every doctor in the National Health Service. I have shown the Minister the kind of thing that the Service sends round. I will now read the kind of literature which the Americans send us. The one I have here is called "Antibiotic Medicine and Clinical Therapy." It carries no advertising except in respect of American products. Each of the articles comes to the positive conclusion that a particular antibiotic should be used.

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These free journals are well known in America but have only recently come here because of the lure of profits under the National Health Service is so strong. Look at the beautifully coloured illustrations; we could not afford to produce such things here, but they pour into our households. They are advertising the whole time. And the Minister wonders why the drug bill is so high!

In case the Minister thinks that I have been making sweeping statements, I want to prove my case finally. This is becoming a national scandal. I will demonstrate this by drawing the Minister's attention to the prescribing of certain preparations known as "tranquillisers." The American public, apparently, has a tremendous appetite for tranquillisers, and these have—

—recently been introduced into this country. These tranquilliser Atarax has been prescribed under the National Health Service at a cost of £7 3s. for 250 tablets. Of course, when one is prescribing tranquillisers one does not prescribe two or three, but 25 or 50 at a time.

The sedative, meprobamate, is sold under the trade names of Miltown and Equanil. This sedative costs £4 for 250 tablets. Miltown was introduced into this country in July this year. It was then costing £6 for 250 tablets, but in June a firm produced another sedative at £4 for 250 tablets so the price of Miltown was immediately reduced to £4. Phenobarbitone tablets which, as the House knows, are a British Pharmacopoeia preparation, cost 2s. 8d. for 100. I admit that if any hon. Member here wanted to be soothed I would give him some phenobarbitone.

We must ask ourselves, and the Minister who is responsible in the matter must ask himself, what is the true value of these drugs to the patient from a therapeutic point of view. The Minister must also say what is the economic value of these drugs. By a pure coincidence, an examination has been made of these drugs. I emphasise the importance of sedatives because, as the Minister knows, a large proportion of the drugs prescribed today are of this variety.

In view of these drugs swamping the market and being called by the attractive
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name of tranquillisers two physicians in the Department of Psychological Medicine at St. Thomas's Hospital, Dr. E. D. West and Dr. A. F. da Fonseca, carried out a controlled experiment of meprobamate which is sold under the trade name of Miltown and Equanil. These doctors conducted experiments on patients, and they also used phenobarbitone.

By a strange coincidence, the Minister will see from an article in the British Medical Journal of last Saturday, 24th November, that I am vindicated in what I have said about some of these drugs. I should like to read the whole of this interesting article, but I will content myself by reading the following passage:
Toxic effects of meprobamate. The sedative drug meprobamate ("Miltown," "Equanil ") is beginning to be widely prescribed in Britain. It is a drug which has been accepted everywhere in the United States both by doctors and by the public, to whom surprisingly enough it is advertised.
The article then goes on to tell how the drug is widely advertised in the United States. It also talks about the side reactions, and finally it says:
In the Journal this week Drs. E. D. West and A. F. da Fonseca report some controlled trials with meprobamate. In one of them they compared it with sodium amylobarbitone in the treatment of 51 patients with psychoneurosis and found the results were almost the same"—
The cost of phenobarbitone is 2s. 8d. for 100 tablets and the cost of meprobamate was originally £6 and was later reduced to £4 for 250 tablets, and the doctors found that the results were the same—
Meprobamate has the disadvantage of costing the hospital dispensary 24 times as much as an equivalent therapeutic dose of a short-acting barbiturate. These considerations suggest that claims made for meprobamate that it is the ideal drug for the treatment of insomnia, tension and anxiety should be accepted with great reserve.
In this limited time I can only reveal what has been done about one or two drugs which are being used in this country, but what about all the others which are piling up our drug bill? What is the Minister going to do about those? I have emphasised time after time in this House that this state of affairs should not be allowed to go on, but still the Minister does nothing. He comes here and tells the people of Britain that in order to raise £5 million he is going to
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tax the sick and infirm. I say that the sick people of this country are being exploited by some of these American drug firms and that the British taxpayer is having to bear the cost. It would be interesting to learn how much money these American firms are taking out of the country.

It has been argued—this is the Minister's answer—that we export £30 million of drugs and that any interference with profit margins here would kill the export trade. That argument certainly has validity when applied to British firms, but it certainly has no validity when applied to American firms which do not export very much, and certainly do not export to dollar markets.

Finally, I am not only concerned with the cost in terms of money of this American encroachment on the National Health Service, but with the harmful effect, both physical and mental, of this high-powered boosting of drugs which caters for the hypochondriac and the neurotic. Here, I suggest, is where the Minister should look for his savings on the drug account and not in the little purses of the sick and aged of this country.

I am glad have the opportunity of following the right hon. Lady the Member for Warrington (Dr. Summerskill) and I am only sorry, as is so often the case when I follow her, that much that she says with which I agree seems to be so exaggerated and distorted that one finds the picture as she seeks to present it somewhat removed from the actual facts of the case with which one is dealing.

I believe that there would be general sympathy in the House with the point of view that the right hon. Lady expressed about the high-pressure salesmanship with which many proprietary medicines today are put on the market. But when she puts the problem to the House, how often she ignores the two vital considerations that have to be faced. The first is this. Is the doctor, or is he not, to be free to prescribe for his patient whatever he in his undivided professional responsibility considers the right medicine for that patient?

It is no good our attacking proprietary medicines and methods of propaganda
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used on behalf of those medicines unless we are prepared to say whether or not we propose to take the discretion away from the doctor and give it to the Minister by means of a list of banned proprietaries that may not be prescribed. I am afraid it is implicit in the right hon. Lady's argument that we cannot rely upon the knowledge and skill of the general practitioner.

I do not dissent from that. The hon. Lady is perfectly right. Nevertheless, if one follows the right hon. Lady's argument to its logical conclusion, one is brought up against that fundamental fact, and it is my personal view that we must at all times safeguard the right of the general practitioner ultimately to provide for his patient what he, in his personal, professional discretion, considers is necessary.

Another point in the right hon. Lady's speech to which I particularly wanted to refer was a remark which she made at the very beginning—that the Minister had betrayed his trust. Much of her speech could have been made when the Bill to introduce charges for the National Health Service was first brought in. And I would remind right hon. and hon. Members opposite that that Bill was brought in under the aegis of Lord Attlee, when he was Prime Minister. If the right hon. Lady's argument is to be applied today, it is an argument which could equally have been applied at that time.

It is not an argument which can be directed against my right hon. Friend.

In considering the whole question of the increasing cost of the National Health Service, a point to which it is worth while referring is the original conception in the Beveridge Report of where our Health Service ought to come in the scheme of social security. I am sure that the conclusion in that Report was right—that the Health Service ought not to be linked with any insurance scheme. I am sure
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that we are right to keep a dividing line between family allowances and the Health Service, which are essentially to be paid out of taxation, and the other elements of the social security scheme, which are insurance elements; and I do not consider that we could meet any increased cost of the Health Service by means of an increase in weekly contributions. That, I think, would be going back on a principle which I am sure was right when it was enunciated by Lord Beveridge.

In my view, we cannot entirely and lightheartedly ignore, as the right hon. Lady ignored, the question of the mounting cost of the Service. The estimate which was given in the Beveridge Report was of about £170 million a year. We all know that the cost of the Service is now running between £500 million and £600 million a year.

I am sure that the hon. Member would not like to mislead the House. We must interpret the figures in terms of the prices of which Beveridge was thinking at that time. It is grossly unfair to make the general public think that the figure is three times as much as the £170 million. It should be related to present-day costs.

—the cost of the Health Service is, if anything, lower today than it was in 1948, when it was introduced, but Guillebaud did not make any comparison, as I was making a comparison, between the estimate given in the Beveridge Report and the annual cost, which today is about four times that estimate.

I think that I had better continue without giving way to the hon. Member.

That being the situation, I think one is also entitled to ask oneself this question: is it or is it not true that a large
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proportion or those who use the Health Service can today afford to make some contribution towards it? My answer to that question is, "Undoubtedly, yes."

—to see that they are well able to afford to make some contribution to the cost of the Service. The problem which we all have to face is not the problem of 90 per cent. of the users of the Service. The problem which we have to face—and it was a problem which the right hon. Lady very properly underlined—is that of, let us say, the 10 per cent.—the people for whom the use of this Service will involve hardship if they have to pay. I do not think that the arguments which can be put on behalf of those people are aided if they are regarded as the typical users of the Service, because I am sure they are not.

I know that the hon. Member has a lot of experience of the hospital services. He must know that under these Regulations thousands of chronic sick will have to pay 4s. and 5s. for a prescription. May I ask him to say, frankly, whether he supports that?

I think I have had at least as much experience of the running of the Health Service, both in the hospital service and elsewhere, as anyone in the House.

If I felt that the hon. Member for Birkenhead (Mr. Collick) had put a case which was factual, I should have grave doubts, but I have made the most careful inquiries of my right hon. Friend about that sort of case, and although I will not anticipate what he will say to the House, I will say that, personally, I am satisfied that the arrangements which he is contemplating are such as to make the cases which have been mentioned almost nonexistent, if not non-existent.

The group of cases about which one is concerned consists of the borderline cases between those who are on National Assistance and those who quite clearly are able to make some contribution towards the cost of their medicine. Such a case may be the person who, until now, has been too proud to collect money from the Assistance Board. Those are the cases about which I feel a great deal of sympathy and upon which, if my right hon. Friend will allow me to say so, I have been very closely cross-questioning him.

The hon. Gentleman will be able to judge when he has heard what my right hon. Friend has to say. I can only say that I have been greatly heartened by the manner in which I have found my right hon. Friend striving in every possible way, by administrative means which he will, of course, explain to the House, to meet the problem of that particular group of cases which has given me, personally, so much concern.

I want to ask my right hon. Friend to do what I feel sure he will do, to watch the working of this scheme in order to see whether the worst fears which have been expressed are realised. If they are, it may be that the scheme must be looked at again. My own expectation is that, just as we had these fears expressed when the 1s. charge was imposed and then found that most of them were groundless, probably we shall again find that the fears which have been expressed recently will likewise be largely groundless. My right hon. Friend would do much if he were to assure us of his intention to be guided by the actual experience of the next few months.

I wonder whether he would consider another point—which occurred to me only today, but which, I believe, has some merit. I do not believe that there is any alternative to the general practitioner's patient going to the Assistance Board for a refund, but in the case of the out-patient at a hospital I am not at all sure that it would not be possible to use the hospital almoner service as a substitute for the Assistance Board. That particular modification might make things easier for a small group of hospital outpatients, and is, therefore, very well worth further consideration.

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The right hon. Lady referred to the point of view of the pharmacist. That point of view has been put to me quite strongly, and I have passed on to my right hon. Friend the pharmacists' fears and doubts. I have suggested to him that an alternative means by which the same result that he seeks could be achieved would be a straight increase in the 1s. That might have been achieved without hardship, because of all the modifications in the scheme which he is introducing to meet hardship. However, he has always turned down that scheme on the ground that it would probably cause greater hardship than the scheme which he himself is proposing to implement. All the way through I have found my right hon. Friend very conscious of the necessity of meeting these hardship cases.

In concluding her remarks, the right hon. Lady indulged in a wholehearted attack, with which all of us must have had some sympathy, on the proprietary medicine, and particularly the American proprietary medicine. On that point, I have this to say to the House. If we look at the whole history of therapeutics over the last fifty years we will see an almost inevitable move towards proprietary medicine. As medical science becomes more and more complicated, as new scientific discoveries come along, so, less and less, can those products be made in the dispensary of a chemist's shop, and more and more, inevitably, have they to be made in the factory. There is no escaping from it.

It may be true that a very large proportion of our prescriptions here are for proprietary medicines, but it is nothing like as high a proportion as it is in foreign countries, In Canada and the United States of America, high-pressure salesmanship or not, from 80 to 90 per cent. of the prescriptions are for specialities.

If there is a Health Service, inhibitions upon generous prescribing by physicians do not exist. Where there is no Health Service, and the physician knows that the patient has to pay for the medicine out of his own pocket, the tendency is for the
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physician to moderate his prescribing. What I am putting to the House is that anybody who objectively examines not merely the type of medicines which are in vogue today, but the tendency of modern prescribing, is driven to the conclusion that, whether we like it or not, the proprietary medicines will play a larger part in the therapeutics of the future.

That adds point to the argument of the right hon. Lady. If that, in fact, is the tendency of medicine—as I am quite certain it is—it places a special responsibility on any Minister of Health to see that there is—I do not wish to use the words "control"—an understanding, both by the public and by prescribes, of the role of medicine of any kind in a community. A great deal can be done to educate the public away from the bottle of medicine. I cannot really believe that this country needs 220 million prescriptions poured down its throat every year.

The basic responsibility for that rests on the shoulders of the general practitioner, but my concluding thought to my right hon. Friend is that, without considerable educational efforts on the part of his Department in relation both to the public and to the general practitioners, he will not find that he can put a serious curb on the increase of prescribing under the National Health Service. I should like to see the curb put on that prescribing, and I think that it can be done, not by control and compulsion but by a system of education. I should like to draw my right hon. Friend's attention to that as a long-term objective which is really likely to produce the economies in the grossly exaggerated present-day bill which all of us here most want to see.

I shall oppose this Prayer tonight. I believe that the Minister could, perhaps, with a less complicated scheme have achieved what he wished to achieve. The big question, however, is whether all this medicine is really necessary. The answer to that is not to be found in a small charge put upon the user of the medicine, but in a much larger long-term project of educating both public and practitioner.

As so many people are worried about these proposed charges, I think it is just as well at the outset to state the position of Her Majesty's Opposition. Her Majesty's
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Opposition is pledged to ensure that when we have a Labour Government we shall have a free National Health Service, and that we shall not torment patients as we are doing today. It is important to say that because, obviously—and this is the kindest thing I can say about them—hon. Members opposite do not understand what they are doing. Maybe it is to their credit that so few of them are on the benches opposite. Maybe I am doing them an injustice, and that they do know what they are doing and are so ashamed of it that there is practically no one on the opposite side of the House who wants to speak in support of what their own Government are doing.

That is one possible interpretation. The other interpretation is that hon. Members opposite cannot really understand the importance of 1s., cannot really understand that in many a household it may be a frightening thing to feel that if one goes to the doctor, and gets a prescription, it will cost 2s., 3s., 4s., or 5s. to get the medicine that has been prescribed. That is one fear among the poorest of all—and National Assistance is not the answer.

Even among the very poorest families, many people do not apply for it because they do not know how to do so. That, too, may surprise hon. Members opposite. There are bewildered people who do not know how to go about this procedure, unless they are already drawing National Assistance and are familiar with the procedure. There are literally millions of people, sometimes old people, perhaps an elderly bachelor or a spinster living on a pension, sometimes families where there are several children, who have to decide whether to pay 1s. extra for a prescription or 1s. for a loaf.

What a monument to a rich men's Government that it should be bread and medicine which they single out for their attack. I should like to understand better how hon. Members opposite see themselves. Do they ever look in the mirror of world opinion? By their foreign policy hon. Members opposite are managing to shock and antagonise American opinion, the Far East and the Middle East. Not only from these benches has it been said that the Government have come within an ace of splitting
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the Commonwealth. They are building up an opposition much more powerful than was represented at the last Election.

Hon. Members opposite have even done what some of us at one time would have thought almost impossible. They have antagonised even the British Medical Association. I do not take the view that a responsible Government must, first, find out what every vested interest wants and then say, "We have got to do that." I agree entirely with my right hon. Friend the Member for Warrington (Dr. Summerskill) when she said that we must find out the facts. But, once we have found the facts, we have got to make our own decision. One of the most conservative professions in this country, a profession which did not fight for a free Health Service, but which is now appreciating more and more the virtues of a free Health Service, is now attacking the Government.

It is amazing to think that the order of priorities among hon. Members opposite is that they must go to the sick and to the children to collect £5 million. What is £5 million to a Government who can spend £1,500 million on armaments? How much are they spending on Suez? Many families are losing the breadwinner to National Service. Many a widow and old man is dependent on a son who would have been bringing in extra money. These are the families who are losing the breadwinner who is serving abroad on National Service fighting for things which many are doubtful about while their families are left struggling to make ends meet.

I began by saying that we on this side of the House are pledged to ensure that we do not behave in such a cowardly fashion. I do not think that the foreign policy of Her Majesty's Government is cowardly so much as stupid. I think that they are living in the past and are unable to adjust themselves to the modern world. But the policy which
they are asking the House to endorse tonight is worse than stupid. It is cowardly and cruel.

I do not wish to speak too long. There are hon. Members who will refer to the Guillebaud Report and who will mention many other matters, but I wish to say that we on this side of the House are pledged to see that we stop this form of petty persecution, and with that pledge goes the obligation to see that not one
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penny is wasted. We cannot possibly be responsible for allowing proprietary medicines to add millions of pounds to the cost of prescriptions if we are satisfied that medicine which is equally efficacious can be provided without those extortionate charges.

The doctor needs our help. We must be certain that the proper equipment can be provided. We will not tolerate a state of affairs in which the National Health Service patient has to accept inferior treatment, and we will not tolerate medicine, however expensive, being denied to the patient. It is high time that there were real economies in the National Health Service so that it can be expanded. It is a disgrace that instead of having more hospitals, better specialist services, and all the things which are still lacking in the Health Service, we should be spending less on it and then attacking the most defenceless and weak in order to save a million or two pounds.

We may not have the power in the Division Lobby tonight to stop this imposition, but we will say with a strong and united voice that we are ashamed of what is being done by the House of Commons because of the dominance of the Tory Party, and that we shall do our utmost to end it.

On a point of order. May I, through you, Mr. Deputy-Speaker, ask the Minister whether he proposes to intervene at an early stage in this debate? Having regard to what the hon. Member for Putney (Sir H. Linstead) said, it would appear that the Minister has some information about the chronic sick which we ought to have before we continue this debate. It would be helpful to us if he were to intervene.

The hon. Lady the Member for Cannock (Miss Lee) has been very vehement in her condemnation of this charge but, as the House has already been reminded, the first realisation that the cost of prescriptions was heavy came when hon. Members opposite were in power.

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This debate indicates three dilemmas. It shows the Minister's dilemma, the doctors' dilemma, and the patients' dilemma. The Minister's dilemma is that his prescription bill is now racing ahead at an alarming pace. The patients' dilemma has already been mentioned, and I would ask hon. Members opposite to realiise that we on this side of the House understand the needs of the class of people to whom reference has been made. Hon. Members opposite seem to forget that everybody in the Tory Party is not by any means wealthy.

The right hon. Lady the Member for Warrington (Dr. Summerskill) drew attention to the doctors' dilemma. I was interested to hear her comments because I think that she, as a doctor, can probably do a good deal in her own organisation to encourage doctors to prescribe differently from the way in which many of them are prescribing. The Guillebaud Report stated that the 1s. prescription had not reduced the quantities prescribed. In fact, the Committee says:
Our evidence suggests that it is now having little effect on doctors' prescribing, other than to lead to some increase in the number of items on each prescription".
That, possibly, is one of the things which has led to this tremendous increase in the drug bill; so many things are being put on the prescriptions, which, indeed, were not advised in the handbook which the doctors have. I would, therefore, say to the right hon. Lady that she can do a great deal to help in this respect.

I am quite sure that every one of us in this House would very much prefer to see money spent on work such as that to which the right hon. Lady referred, work which those of us who are deeply concerned in the Health Service know is needed, namely, the improvement of our hospitals. A great deal of improvement in our hospitals is needed, and we can do that if we do not have to spend so much in this other direction.

I agree fully with the right hon. Lady in her denunciation of the prescribing of expensive drugs in place of those at much more reasonable prices, produced in this country, which could be prescribed.

The hon. Lady the Member for Wythenshawe (Mrs. Hill) has suggested that there is a tendency among doctors to prescribe many more items on a single
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form, and that they really ought to observe the handbook recommendation. Is it not a fact that our handbook recommends two prescriptions on the one form, and that the average number of pre scriptions on any one form at present is 1.75?

Yes; but what has helped to add to this enormous bill is that so many more have been prescribed on one form, with the result that a good many people have been getting their prescriptions much more cheaply than they would otherwise have done. The suggestion we are now considering is one way in which that might be minimised.

To return to the subject of expensive drugs, no one here would wish patients to be denied the benefit of something absolutely brand new which is very much better than
anything we have had before. We all want to see patients receiving the benefit of those drugs. But we do not want to see them treated with expensive drugs such as those mentioned by the right hon. Lady the Member for Warrington.

I would ask my right hon. Friend the Minister of Health to take very careful note of any cases of hardship which may be brought to his notice. I am as anxious as anyone else that the administration of this Service should be as simple as possible and that we should spend as little money on unnecessary things as possible. I have had in mind one possible way to save a good deal of the coming and going which is involved, getting the receipt, going to the Post Office, and so on. I am not suggesting that there should be a special form, but I have wondered whether it might eliminate some of the administrative work if doctors would, on production of the National Assistance book in appropriate cases, put the number of that book on the prescription form.

If that could be done, the patient would then not need to claim anything at all; chemists already have to sort out into various categories their prescription forms at the end of the week. I should have thought that that might have been one little thing which could be done to ease the burden on a good many people.

On the other counts, I hope that a patient who is attending hospital will not have to make two journeys to collect whatever is prescribed. I am as anxious,
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I think, as anyone else in this Chamber that those people who are not in good health shall not be put to greater disadvantage than need be.

I hope that the Minister will examine some of the suggestions which have been made. By all means, let us spend an adequate amount of money on our Service. By all means, let us give our patients the best. But we must not waste, and this, I think, is one of the ways that the Minister sees as an attempt at stopping waste. Let it be a lesson. So many people have the idea that all the cost of the Health Service comes out of what is paid each week for their stamps.

My hon. Friend the Member for Putney (Sir H. Linstead) mentioned that the Health Service should be paid for out of taxation. We should all realise that the greater part of the cost does come out of taxation. It has been suggested that probably about £40 million is taken from the weekly amount subscribed, and that all the rest comes out of taxation. I sincerely feel that it is up to everyone in the country to realise that what we have we must pay for, and that if it does not come out of the left-hand pocket it comes out of the right-hand pocket. Realising that, let us use the Service wisely.

It must be a long time, I think, since we had three hon. Lady Members appearing so prominently in any of our debates at such an early stage. If I do not attempt to deal with some of the technical questions raised by my right hon. Friend the Member for Warrington (Dr. Summerskill) or with points raised by my hon. Friend the Member for Cannock (Miss Lee), I hope they will excuse me, because I would prefer, during the few moments I wish to detain the House, to refer not to the technical considerations, the largely professional aspects of this problem of the increased cost of prescriptions, but rather to the economic impact on the poorest families of these proposals which many of us so deeply resent.

I have the honour to represent a Lancashire constituency where, due to the shifting of population and the drift of industry to the newer industrial areas in the South, we have an inordinate proportion of old people in our communities. It is particularly among those comprising
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that section of the community, pensioners over 65 years of age, many of whom are oppressed by chronic sickness, that the deepest resentment will be felt.

In this House we have the privilege of representing the people of our country in our various constituencies. It is, surely, our honourable duty here to make articulate the feelings of those who will be called upon to pay this additional penal tax under the Minister's proposal. I say quite sincerely that I am sorry to see the Minister of Health sitting on that Front Bench tonight as though he were sitting at the "penitents' form". His may be the administrative hand, but really it is his overlord, the Chancellor of the Exchequer, who has decreed what is proposed.

How foolish and how anti-social it is for any Administration which sets out, as the Chancellor said some months ago, to achieve an overall saving of £100 million in public expenditure, to say to the Minister of Health that his share shall be £5 million out of the hundred. He has not considered its implications but has merely placed a poll tax on the National Health Service. He has forgotten that we have in this country about 6£ million people over the age of 65, of whom nearly one million, old men and old ladies, are living alone. Often they are sick people who require very much in their remaining years the services of the National Health Scheme.

We have to consider not only the old people but the married couples in failing health and requiring constant medical attention who, out of their pension of 65s. a week, may be called upon to pay up to 5s. or 6s. a week for these charges. It is no use the Minister telling me when he replies, as no doubt he will be qualified to do in his defence, that he is making provision for these people to seek National Assistance. Many of my constituents are still too proud to go for National Assistance. If they are suffering physical illness, they should not have added to their anxieties all this chasing about to get a book-keeping transaction put right and to obtain reimbursement.

Without exaggerating in any way, I should like to put before the Minister a typical case which has been brought to my notice—I hope that my colleagues
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who succeed in catching your eye, Mr. Speaker, will do the same—to illustrate, not theoretically but practically, the implications of the Minister's action. I quote the case of a man who 20 years ago became a victim of epilepsy.

He was at that time a man with a good future, who had qualified as a colliery under-manager. He was working underground, and if he had been able to continue at his chosen avocation he would today be earning very high wages. This man, unfortunately, fell by the wayside and began to develop epilepsy, to which my right hon. Friend the Member for Warrington referred in opening the debate. He did not lie down to it, but took proper medical advice and was supplied with the usual barbitone and the newer drugs which are use for treatment.

By constant medical treatment for over 20 years this man has been able to maintain himself and his family by suitable light employment. Had he been in any way a malingerer, he could at any time have secured medical evidence of total incapacity and become a charge on public funds—National Insurance, National Assistance and all the rest. His position is typical of thousands of others.

In future, he will be called upon to pay up to 6s. on each occasion that he goes for the three or four types of drugs which are prescribed for him. He is already living on the margin of subsistence because he earns only a low wage. It is scandalous that this House of Commons, the guardian of the liberties and interests of the common people, should assent to any proposal by the Government to penalise those who by sickness or poverty are already the hardest hit members of the community.

I conclude—I know there are many others who share my indignation—by referring to the hon. Member for Putney (Sir H. Linstead), who is not at the moment in his place. [An HON. MEMBER: "He has gone for a tranquilliser."] I do not know whether he has gone to take a dose of tranquilliser. I could suggest parts of the world where we might export large doses with good effect on the politics of this country.

I felt very sorry that the hon. Member for Putney, who is highly respected in this House and is accepted as an authority on
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many of these questions, in which he is professionally interested, should put himself in the position of being used as a stooge to defend the Minister, because I do not believe that he had much confidence in the brief that he was reading to us.

I hope that in spite of the strong expressions which, no doubt, will be made from these benches—I have made my contribution as modestly as I can under great provocation—this matter is not allowed simply to be settled, as so many things are, by the ringing of a bell at about ten o'clock or half-past ten when most of the Members on the Tory side have not even troubled to come to listen to the argument. Perhaps I ought not to condemn the method of deciding things by Divisions, as I am a party Whip. That is one of the ways in which the House machine works. I know that there are hon. Members on the other side of the House who, to their great credit, still have some human instincts. If they are not able to secure a reversal of this policy by persuasion of the Minister, if the matter is to end tonight in the ringing of bells and the shepherding of hon. Members opposite into the Lobby, the only redress left to us on this side of the House will be to redouble our efforts to dear out this Government, who have betrayed every undertaking they gave to the public when they obtained their mandate.

I am pleased to follow the hon. Member for Westhoughton (Mr. J. T. Price), because we are both Lancashire Members and in some way our two constituencies are similar. The hon. Gentleman referred to the way population has drifted from South Lancashire. The same thing is happening in some of the towns of East Lancashire. I know well the problems to which he has referred, such as the elderly who have to have medicines and more intensive medical treatment than those of us who are younger.

However, this problem of charges in the National Health Service has recurred regularly, in 1949 and 1951, when the party opposite was in power, in 1952 and now in 1956. Both parties have been confronted with exactly the same problem. The basic problem was well put
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by the right hon. Gentleman the Member for Middlesbrough, East (Mr. Marquand) when he was Minister of Health. He said:
It was absolutely necessary to obtain money from charges upon some other parts of the Health Service so that we could maintain the essentials."—[OFFICIAL REPORT, 24th April. 1951; Vol. 487, c. 238.]

The then Labour Prime Minister, who is now in another place, made a comment which is as apposite today as it was when he made it. He said:
The purpose"—
that is, of the charges—
is to reduce excessive and … unnecessary resort to doctors and chemists, of which there is evidence which has for some time troubled my right hon. Friends the Minister of Health and the Secretary of State for Scotland."—[OFFICIAL REPORT, 24th October, 1949: Vol. 468, c. 1019.]
So the problem has been with us ever since we started the National Health Service. It is not peculiar to this country. In countries like Australia, where, I am glad to know, they also have a national health service, they have the same trouble with the cost of prescriptions. The only way in which hon. and right hon. Gentlemen opposite, when they were in the Government, could tackle it was by imposing the 1s. charge, at a time when the pharmaceutical bill was some £30 million. That bill is nearly twice as large now. The increase is really remarkable, and if that policy was sensible then, it is sensible today.

The hon. Member is usually fair in these matters. Will he get the record straight? The 1s. prescription charge was imposed because of alleged abuses. It has been in operation now for a period of years. The then Minister of Health, now the Minister of Labour, appointed the
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Guillebaud Committee, which has generally reported that, if there was any excess at all, the original prescription charge had achieved its object. But the present charge is not being imposed in order to remove excesses, but to obtain about £700,000 between now and next March. The Chancellor has said that, and the hon. Member has to answer his right hon. Friend.

The hon. Member has given a possible explanation, but it is not the explanation which the then Minister of Health gave when he introduced the Bill in 1951.

The hon. Lady the Member for Cannock (Miss Lee) said that drugs were to be prescribed entirely free if her party returned to power, and yet in some way, which was not specified, there was to be some restriction. There was to be no waste. Had she in mind that the Labour Government would do what I hope no Conservative Government will ever do, that is, direct doctors on what they could or could not prescribe?

I welcome the opportunity to intervene, because I was alarmed by a remark by an hon. Member opposite, which seemed to suggest that doctors were prescribing too many items and that steps should be taken to limit them. My point was to the entirely opposite effect. It was that National Health patients must have the medicines they require, no matter how expensive they may be, but that if a racket was being run in proprietary medicines which had precisely the same component parts, the doctor must have the protection of the Government in prescribing what the patients need, without the drugs costing five, ten and sometimes twenty times as much.

I am grateful to the hon. Member for Fife, West (Mr. Hamilton) for reminding me. I had not intended to discuss these matters very much further because I have absolutely nothing to do with the manufacture of pharmaceuticals. I have been long associated with a company, one of whose branches manufacture pharmaceuticals, but I know as little about the industry as does the hon. Member. [HON. MEMBERS: "I.C.I."] I am glad that my hon. Friend the Member for Putney (Sir H. Linstead) has dealt with these points, because he is an expert on the subject. I was speaking about proprietary drugs, and I understood that the remarks of the hon. Lady the Member for Warrington (Dr. Summerskill) were directed at American drug firms rather than British drug firms with which I have been long associated.

The right hon. Lady emphasised strongly that the medical profession was much opposed to these charges. If I remember aright, both the British Medical Association and the Medical Practitioners Union were opposed to charges in the case of previous legislation passed while I have been in this House. So the arguments used today are the same as those used on previous occasions when we have discussed this matter, and are not aimed specially at the proposal of my right hon. Friend.

I want to draw the attention of the Minister to one more point. We have not been too happy about the way in which relief can be given through the National Assistance Board. I wonder whether my right hon. Friend would reconsider a suggestion made originally by my right hon. Friend the present Minister of Labour in a debate in 1951?

On a point of order, Mr. Deputy-Speaker. The Opposition previously drew your attention to the very small numbers at one time on these benches. Those of us who are here are desirous of hearing the speeches, and I wonder whether the Opposition could be a little quieter?

Anyway, Sir, I have a fairly powerful voice. The proposal made in 1951 for simplifying the way in which the National Assistance Board can give help was that a system should be adopted
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for prescription and other charges similar to that of the home help service. Such a system might be very suitable in the present circumstances, when perhaps more people may have to apply to the National Assistance Board than they had to with the 1s. prescription charge.

It would appear so far that from the other side of the House we have heard a number of alleged experts on hospital management boards, pharmacy and Imperial Chemical Industries. Perhaps it might be refreshing to look for a change at the other side of the picture. One thing which struck me was how remote are the people closely associated with hospital management boards, pharmacy and I.C.I. from the real problem which will arise from these Regulations.

This is much more of a human problem than has been suggested so far in the debate. Naturally, none of us wants to see expensive drugs prescribed if cheaper drugs are available, provided they do as much good and are suitable substitutes. May I ask some of those who have spoken this evening about the cost of the National Health Service whether they realise the benefits we have had from it? Has anybody given any thought to the people who are alive today simply because we have a Health Service?

Has anybody remembered that right hon. and hon. Gentlemen opposite voted against the National Health Service? Do they think that our memories are as short as that? If savings of £5 million have to be made, why have they again so viciously attacked that section of the community? Let us be more realistic. It is a most contemptible and mean thing to do to attack the sick and the poor. It is something that no respectable or decent representative anywhere would condone for a moment.

Let us consider some of the aspects, because, whatever arguments may be produced on either side, at the end of the day the result of the increased charges is a tendency to reduce the number of medicines which may be deemed necessary. How many people realise exactly what medicines are required for some diseases?

Let us take coronary thrombosis, which is a horrible, killing disease. It is
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responsible for more deaths in Scotland than any other disease. I do not know what the figure is in England, but I do know that deaths from the disease have increased five times during the last twenty years.

What kind of medicine is prescribed for victims of coronary thrombosis? I am not a doctor, but I happen to know a little about the subject. I know that one thing required is trinite. One also probably requires amyl nitrite. It is necessary to give people not only a chance to live but also a chance to work, when working is important, and this is an additional benefit to be obtained from the National Health Service. In addition to those two drugs, one might require pethidine, to kill deep pain. Also, today hospitals and doctors prescribe micardol as a preventive measure against angina attacks. So far, we have four drugs.

Many victims of coronary thrombosis also have prescribed an anti-coagulant which slows up the coagulation of the blood and minimises the danger of their having a fatal clot. We now have five medicines. Also, pheno-barbitones are prescribed, not as tranquillisers but merely so that people may settle down a bit. Further, so that sufferers may get a little sleep, they may be prescribed nembotal or sodium amital or some other drug. So far, we find that the victim of coronary thrombosis may have seven medicines prescribed. That does not exhaust the list.

Let us take the case of a person suffering from diabetes. He will require insulin. There are more than two types of insulin, but two types are within my knowledge, and these are the soluble insulin, which acts rather quickly, and the protamine zinc, which lasts over a longer period. In some cases a diabetic has to take some of both types. It depends entirely upon the degree of seriousness of the disease.

The diabetic may have to undergo a test to discover whether or not his diabetes is active. He has to have some solution for the purpose of this test, and this may be provided by means of Benedict solution or something in tablet form. For these things and other things he may have to go backwards and forwards to the doctor. He will require hypodermic needles and a hypodermic syringe, and also, from time to time,
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replacements. He will also need cotton wool.

Because of the nature of the disease, the diabetic is also subject to skin eruptions and other troubles which are difficult to cure. Even though one has no medical knowledge, one must realise that he requires prescriptions for bandages and ointments. In fact, there are about eight things, without going into the matter too deeply, which a diabetic is most likely to require.

Although I do not have any medical knowledge, it is within my experience that a diabetic may suffer from coronary thrombosis. Indeed, that often happens. If we add together all the drugs and other items which I have already mentioned, we appreciate what a number of prescriptions may be required.

Persons in the conditions which I have described are usually in a very low general state of health, and they are subject to all sorts of complaints which require prescriptions. There is no need for me to go any deeper into the matter of what is required by sick people in the lowest income groups to make hon. Members appreciate the damage, hardship and distress caused by the introduction of these increased charges.

This is a human problem, one which nobody can slide round by mere excuses about what was done by the Labour Government some years ago, even if for a limited period. Let the Minister and those who support him be conscious that he is inflicting a hardship on the people who can bear it least and is causing greater damage to the country's economy than the expenditure of a miserable £5 million. He may be restricting the recovery of people who are sick and who need careful doctoring and ample medicine when necessary and of the right type.

It is perfectly clear that if one has health, one has the possibility of being wealthy. This is attacking the unhealthy because those who suffer a degree of bad health are very often lacking in wealth. I intended saying something about old-age pensioners. I have already heard the lovely story, the lovely excuse, about the National Assistance Board.

The Minister of Health had considerable experience at the Ministry of Pensions and National Insurance and realises that there are many pensioners and others
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living on small, fixed incomes those living on National Insurance payments of all descriptions who are borderline cases and who, simply because of a bare 1s. do not now come within the scope of the scheme. They are denied the benefit of free spectacles and a whole range of other benefits simply because they are borderline cases. There are the very people again who, because they do not qualify for National Assistance, will suffer. Will the Minister make any provision for that sort of case?

I force myself to conclude. There is very much more that I wanted to say. I have seen many sufferers from all these complaints. I have seen them sitting hopeless and almost in despair, anxious about their illness and facing the fear of poverty. The Government and their supporters are making that situation worse tonight. They are running true to form. Nobody expected much of them, but what a destructive thing they are doing tonight! They did not like the Health Service in the first place. They have had several bites at the cherry in an attempt to destroy it, but by their action tonight they are, in fact, destroying themselves.

I want to confine myself to one particular aspect of this subject which we all have very much at heart. I speak in the knowledge that it is the full intention of my right hon. Friend to alleviate cases of hardship wherever possible. On this side of the House we are all confident that that is the earnest intention of my right hon. Friend while bringing in these charges.

In doing that, I should like my right hon. Friend to look closely at a list which I have submitted to him of life-saving drugs and their appropriate diseases, concerning which I asked a Question in the House last week and about which I should like to speak. The list covers all categories of serious diseases, including those which the right hon. Lady the Member for Warrington (Dr. Summer-skill) mentioned and those to which the hon. Member for Kirkcaldy Burghs (Mr. Hubbard) referred. I shall refer to the list in detail in a few minutes. Before doing so I want to say something about the proportion of the total number of prescriptions which the drugs in such a list represent.

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A test has been carried out at a London chemist's, and it has shown that the percentage of prescriptions relating to these life-saving drugs as compared with the total number of prescriptions is about 4¾ per cent. Out of a total of 3,252 prescriptions presented, only 156 contained these drugs. I must admit that the cost of these drugs is considerably more than the average. Whereas the average cost of other drugs is 7s. 8d., the average cost of the life-saving drugs is 19s. 7d. Therefore, from the point of view of cost, lifesaving drugs account for about 12 per cent. of the entire total.

It is important that we should have some appreciation of what the total cost to the Service would be if we eliminated these life-saving drugs from liability to a prescription charge. According to the figures which I have here, the total amount of contributions from the public is about £6,870,000, and 12 per cent. of that is about £800,000. That means that my right hon. Friend would have to forgo approximately that amount of money if he made these drugs freely prescribable, but I put it to him that that would be a comparatively small proportion of the total figure, and, also, that if he took this course he would eliminate the necessity of many people having to get their shillings back from the National Assistance Board, thereby avoiding duplication.

I admit that it is difficult to define diseases, and that if people with certain diseases were to have their prescriptions free of cost some difficulty might arise. There would, naturally, be a certain amount of pressure from the public in this matter. If care were not taken there would be a danger that people would be classified as suffering from heart disease when their hearts were not in a very bad condition, or from a bacterial disease when they merely had tonsillitis. That is a danger in any arrangement of this kind.

What I have said applies in a small number of cases. The majority of the diseases to which I am referring—cancer,
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tuberculosis, blood diseases, such as leukaemia and epilepsy—are clearly defined entities. But there is clearly a marginal number of diseases, of the kind I have mentioned previously, in respect of which it would be difficult to lay down definitions.

I come now to the point raised by the hon. Member for Perry Barr (Mr. C. Howell). Of course, we should require the co-operation of the doctors in the matter. There would have to be some sort of scheme defining the position which would demand the co-operation of the doctors. I am quite sure that the medical associations would give their cooperation in the matter particularly if, as I personally think can be justified, their private patients were also included in such a scheme.

I am positive that something could be worked out with the collaboration of the medical associations whereby marginal diseases such as bacterial diseases in which it is difficult to draw a line—heart diseases and that sort of thing—could be defined for inclusion in such a scheme. Therefore, I would press my right hon. Friend to look at this list again to see whether something can be done, perhaps by a kind of pilot experiment such as the test by a chemist to which I have referred, to see whether some modification of this kind can be made.

I would like to conclude with a word on the question of proprietary drugs on which I can speak with some experience. Naturally, I agree with the remarks of my hon. Friend the Member for Putney (Sir H. Linstead) when he says doctors must be left to decide what is best for the patients. None the less, I also agree with what the right hon. Lady the Member for Warrington said about the immense pressure that is brought to bear on doctors in the matter of advertising at the present time, particularly by American firms.

I can produce an even better exhibit in that connection than was produced by the right hon. Lady. I had an almost complete anatomical atlas handed me one day by a traveller in my surgery. He handed me this expensive publication and went out of the surgery in a matter of two or three minutes. That is the type of pressure, particularly from American firms, that is being put on doctors at
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present. I hope that my right hon. Friend will look at that matter also and consider whether savings can be made in that way, and thus avoid the present distressing situation. I oppose this Prayer because I believe that with modifications of this kind the present proposals can be operated without hardship.

I think it can fairly be said that the vast majority of doctors would undoubtedly co-operate in the matter of prescriptions and would prescribe National Health Service formulae if they were available instead of proprietary brands of drugs. I do not deny that there is a large scope for economy. I accept all that, but having said so, I do not see, for many of the reasons already given, why the Government should introduce these charges.

I propose to be very brief in my remarks because I know that several other hon. Members wish to speak, and also so that I may be able to carry out the orders of my own Front Bench. In order to let the House know that I am talking with some knowledge on the subject, I have in my hand a brief prepared by doctors in my own constituency. I hope that the hon. Member for Putney (Sir H. Linstead) will do me the honour of reading my speech.

I propose to quote from figures given me by these doctors in order to prove that this charge will create the hardships which some of my hon. Friends have already outlined.
I have been given figures by
responsible people, doctors who have been associated
for many years with a medical mission in my constituency where the chronic sick are treated. They have had vast experience. I do not know their politics; so far as I know, they are not favourable to my party, but on this occasion they have asked me on their behalf to express their fears.

They tell me that already their patients are terribly worried about the effects of the new charges. There is great distress, and already attempts have been made by many patients to try to hoard parts of the supplies given on present prescriptions. They say that the immediate problem will be that of finding the ready cash to pay for the new charges.

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One of the biggest problems in constituencies like mine is presented by the home bound chronic sick. Will the Minister tell me how they are to find the money? Will they be given a prescription which
will immediately entitle them to what is prescribed or will they have to have 5s. available? If they have not got the money, how can they get it? What about the chronic sick suffering from heart disease who
might be called upon to pay a fee of 5s. and who might be asked to go to an Assistance Board three miles away from home? How do they get the money?

That is one of the problems about which these people are worried. The
prescription charge of 15/25/2007s. has already created a tremendous hardship in this respect, and when we glibly talk about the fact that people can easily get their money back from the Assistance Board, we ought to remember that these people must have the money in their pockets in the first instance to pay the fee. Now they will need to have 4s. or 5s. available.

An analysis has been done of the prescriptions given to one hundred old people during the months of September and October of this year who were attending the out-patients' department for geriatrics. These are the figures. Six patients only were given prescriptions for five items; 30 were given prescriptions for four items, 38 were given three items on a prescription; 16 were given two; and 10 were given one. In other words, 68 of those 100 patients had three or four items prescribed on one prescription.

The reason is that these patients had either blood pressure, heart trouble, bronchitis, ulcers, dyspepsia or arthritis, and needed extra items on the prescriptions, as will be understood. I inquired of this clinic what would be the response to the Minister's suggestion that he would allow the doctors to give package prescriptions of, say, a three months' supply in advance. That is what the Minister will tell us tonight. He will say that these doctors will be allowed to prescribe a three months' supply in order to avoid great hardship, and that this will all be done on one prescription.

They have asked me to say to the Minister, and I am glad to be given the opportunity to say it now, that if they prescribe in the fashion which he has suggested the result will be a tremendous
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waste of public money, because in cases of this kind it is essential for the patients to have constant medical attention. The doctors have frequently to change the prescriptions. Where on one occasion they may be giving treatment for heart trouble, perhaps the next time they see the patient there are other symptoms which call for an entirely different treatment. The doctors encourage these patients to come again and again to the clinic so that they can be kept alive.

A reasonably fit person who suffers an illness has to pay 3s. or 4s. on a prescription, and then he can go to the Assistance Board to collect the money, but does not the Minister agree that the people about whom I am speaking will not be able to do that? The constituency which I represent is typical of many in the London area. The population has decreased, and one in five are old people. The effect of all that the present Government have done since they have been in power has been badly felt by these old people.

In the main, those people have never voted Tory. One can well understand why they do not vote Tory. What a crowd hon. Members opposite are! They are so unfair. The Minister and his hon. Friends will not support an investigation into armaments, costing £1,500 million a year; that can be spent at any time. When it is suggested that we should have a Geddes axe on that expenditure, they are not a bit interested. But they propose to find £5 million from prescriptions. They ought to be thoroughly ashamed of themselves.

I hope the hon. Member for Bermondsey (Mr. Mellish) will forgive me if I do not follow him in his argument, but I wish to make only one short point. I am perfectly confident that the Minister will do all he can to alleviate cases of hardship where-ever possible. I must say that I do not like these charges, especially as they affect old-age pensioners.

I trust that everything will be done, where possible, to see that people do not have to draw National Assistance in order to pay the extra
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charges. In my division old-age pensioners do not like going to the National Assistance Board. They would rather work than go there.

My purpose in speaking tonight was to draw the Minister's attention to a letter which I received this evening from a constituent. It reads:
Now, Sir, if the said pensioner applies to the N.A.B. he is told that if he owns property and has no hire-purchase payments he cannot obtain assistance. Not very conducive to thrift, is it?
I hope the Minister will assure me that any cases like that will be dealt with most sympathetically, because it is such cases which make the Opposition play on the feelings of old people.

The first charge which I want to make against the Government is that they have underestimated the value of human life. They have failed to appreciate the effect which the policy they are now pursuing will have upon the sick, the aged and the infirm.

In the few minutes at my disposal the first thing I want to do is to read an extract from a letter, which I have received, among many others, protesting against the Government's policy. This is not a cry from Macedonia. This is a letter from a paraplegic case in Staffordshire. This man has been twenty-two years a cripple, and for fourteen of those twenty-two years he has been bedridden. This is what he writes, among other things, in a rather long letter:
I express the hope that before passing legislation for the proposed charges to become operative the Government will pay heed to the protests made and the observations made on behalf of the sufferers of diabetes, cancer, disseminated sclerosis, the aged, and the maimed and disabled, the chronic sick, and all who will be affected should the charges be implemented, for the persons who are in the most need will be the people with the greatest burdens to bear.
I do not know this man but I know that he is typical of hundreds and hundreds of cases in this country today. Yet we have the Government telling us that to effect economies they must increase the cost of prescriptions and the items thereon to 1s. per item.

I re-emphasise what I said in the House on 9th November. Any Government which seeks to restore the economic
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stability of the country by inflicting greater hardships on the poor, sick and aged people is bankrupt of ideas, especially when there are so many avenues that they can tap to effect economies, and which I would enumerate if I had the time.

The Government are seeking their economies by inflicting hardships on the already over-burdened poor and aged, and, in doing so, are showing that they are more concerned about £.s.d. than about the health of those people. From information which I have received on very good authority, it appears that nine men decided that this policy should be pursued; nine men who do not understand what poverty is; nine men who are too far divorced from the actual conditions prevailing in the homes of our people, especially in the industrial areas.

They come with these proposals—and I wonder whether they have taken the trouble to examine the argument advanced in support of them? They say that between 1st December, when these Regulations become operative, and 31st March of next year, they will save £750,000, and, in a full year, will save £5 million. I wonder what the Lord Privy Seal has to say about the promise he made as Chancellor of the Exchequer? It will be within the recollection of hon. Members that in 1952 we had a very lengthy debate on the economic affairs of the country.

Many of us on these benches then had grave apprehensions that the Government then had in mind a policy—although they did not reveal it, we feared that it was in their mind to undermine the structure of the National Insurance Scheme. To allay our fears, the then Chancellor said that they would maintain the structure of the National Health Service, but would make charges where they could best be borne. Have the Government kept that promise? This proposal is exactly the opposite to what they promised, and inflicts further hardships on those least able to bear them.

We have been told many times before that all those people who are in receipt of National Assistance will have an opportunity afforded them to ask for a refund. Surely, Mr. Speaker, we have not reached the stage when we are to force poor, sick, infirm people to trail down to the National Assistance Board
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for a refund of 3s., 4s. or 5s. Have the Government no better policy than that? Is there not in their hearts and souls a bit more Christianity than they have so far manifested? Are they hard-hearted? Can they not lend a listening ear to those people on whose behalf we plead?

Let it be remembered that, as we on this side know from our experience in our divisions, those who make application for supplementation must be in dire need. They have nothing to spare—nothing at all. Unless they prove that they are in dire need then, as we say in Lancashire "they won't get the brass." I want to remind the Minister that there is a starting-point. What about the poor people who cannot
pay the 1s. to the chemist to start with?

I have with me a list, supplied to me by a chemist in an industrial area in my division, of people who have had to borrow money to pay for their prescriptions. We hear it said that the extra cost represents another 1 per cent. or 1.75 per cent., but it must be remembered that these people have four or five items on their prescriptions. How can they meet this extra cost?

The House should adopt a correct approach to this matter and should examine the number of people now receiving National Assistance. On 29th March, 1955, there were 1,807,466 in receipt of National Assistance. That was the highest figure ever recorded in the history of the country. Yet the Government tell us that we are in a much better position than we were. The acid test whether we are enjoying a higher standard of living is to find out the number of people on National Assistance, and I agree that there has been a gradual reduction in the number. On 31st October, 1956, the number was 1,635,000.

On 1st February, 1954, when the present Minister of Labour who was then Minister of Health was asked how much it would cost to cancel out altogether the payment for prescriptions, he said it would cost only £900,000 a year. Here we are in this House quibbling about spending £900,000 a year to help the sick, the infirm and the aged. Surely this nation is not too mean and parsimonious to provide that paltry sum to the old people. Many of them when they were fit and strong gave to industry, nation and to the world their strength, devotion and
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courage, and apparently this is the way that we intend to treat them. However much I try, I cannot for the life of me believe that such is the case.

I plead with the Minister to take these Regulations back, to have another look at them infuse into that examination the Christian outlook. If the Minister wants any evidence of the fact that he is doing wrong, let him examine some of the newspapers. I have no desire to weary the House by quoting from them, but practically every leading newspaper, including The Times, the Manchester Guardian and the Pharmaceutical Journal, among the many that I have read, is opposed to the increase in the prescription rates. I have failed to find one newspaper which is prepared to support the Government's proposals.

I want to say a word or two about a section of the community which we are apt to forget, paraplegics, and particularly those in mining areas. Those of us who come from mining areas are aware of the great expense that has to be borne by these people.

We have just completed a survey which reveals that in the coalfields there are over 600 men who are paraplegics, men who have been bedridden for nine, ten and up to twenty years. I want the Minister to appreciate the circumstances of those men and what their illness means to their womenfolk, the wear and tear which they experience as a result of the terrible complaint which these men suffer. These poor fellows lose control of their bowels, and there is incontinence of urine. It all adds to their pain and suffering, and to the work which their womenfolk have to do in the extra washing of bed clothes. It is essential that they be kept clean.

Surely a broader and more humane view ought to be taken. If I may say so, the Government ought to have a loftier and nobler conception of human life. When they do, they will become better and more understanding statesmen of the country in which they live and which they are supposed to govern.

I have never felt greater regret at interrupting a debate than I feel now, but I find it my duty
704
to intervene at this stage. I am standing in the way of a flood of feeling and indignation, which has been expressed already by some of my hon. Friends, and particularly by my hon. Friend the Member for Ince (Mr. T. Brown) who I am quite sure touched every heart.

After listening to this debate, I take the view that there is not one person in this Chamber tonight who does not share our view about this charge on prescriptions. It is quite obvious from what has been said by every hon. Member on the benches opposite that each of them is trying to find some way to salve his conscience in supporting the Government. I was most disappointed by the speech of the hon. Gentleman the Member for Putney (Sir H. Linstead). He knows the facts. It is quite obvious that he has been at the Minister behind the scenes, trying to press him to do something else.

It is quite unrealistic to suppose that this debate has anything to do with medical matters or with prescriptions in the sense that there is a medical reason for this charge. There is no pharmaceutical reason for it. Everybody knows that it is purely a budgetary charge. As one of my hon. Friends said, this is part of a scheme on the part of the Chancellor by which he is supposed to save £100 million. He never asked anybody whether it could be saved on health or not.

My right hon. Friend the Member for Warrington (Dr. Summerskill) described this proposed charge quite properly as a tax. It is a sheer waste of time to discuss the matter from a medical angle or from any angle other than a tax angle. The only point is this. If one is considering levying a tax to raise £5 million, should it be levied on the sick and the maimed?

My right hon. Friend described it, quite rightly, as financial sanctions on sickness. She gave an instance where it was possible that £1 a week for prescriptions might have to be paid. Is it suggested that if one wants to raise £5 million, when there is a Budget of about £8,000 million, that extra £5 million should be levied as a tax on the sick and maimed of this country? I am quite confident there is not one single person of intelligence in this Chamber tonight who could justify such a proposition.

We know what happens, of course. One hon. Member tried to justify it by
705
what had been done before. But we are quite aware of what really happens: every now and then the Government feel they must make some sort of gesture of penance; it is a sort of ritual. They hit on a figure—£100 million—without any sense at all. Then, once they have hit on the figure of £100 million, they wonder who is going to pay.

Any sensible person could suggest where it could readily be saved. It could have been saved by not going into Suez. The £100 million could be saved quite easily in many ways that we could suggest. But, of course, that would not work, because the War Office would say, "Why should we provide the £100 million?". The Ministry of Pensions, the Ministry of Health, and the Ministry of Labour must all do their share. Since it is a gesture of penance, everybody must suffer. It is the wrong person who is occupying the Minister's seat tonight. It is the Chancellor of the Exchequer who should be there. This Minister has absolutely nothing to do with it.

Let us see how this works. The Ministry of Labour has to out down. The only people in the Ministry of Labour are those serving the public at the counters and their service is calculated according to the weight of the population they serve. The only way, therefore, in which the Minister of Labour can save money is to cut down on the service to the public, so that the public must stand longer at the counters because the Chancellor of the Exchequer thinks that something should be saved in the Ministry of Labour.

When we come to education, the main expenditure is teachers' salaries and the cost of buildings. Salaries cannot be cut down because they are done by agreement. What happens, therefore, is that there is a cut on children's meals. That is the only place where the saving can be made.

When we come to the Health Service, the main item is doctors' and nurses' salaries. The reason that the Health Service went up in cost was that for the first time in history we had to pay the nurses decent salaries. When they and the doctors got a rise in salary, up went the cost of the Health Service. Does any Member opposite object? If so, let him rise and say so.

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For a generation, the nurses were exploited. Even now, they are not getting the conditions, the leisure or the relief that they ought to get. Nurses have always been giving service from their vocational interest in their work, but for generations they were exploited. What we did was to raise their salaries, and that, of course, raised the cost of the Health Service considerably.

Quite obviously, therefore, these abitrary economies make nonsense from any sensible point of view. In the Health Service, we are told that expenditure must be reduced. The order to the Minister and to the Secretary of State for Scotland is that they must find £5 million. I have been at the job and I know what happens. We cannot reduce doctors' or nurses' salaries, so then we come to the patients. The whole service exists for the patients, but the service to the patient is being cut down. It does not exist for the doctors or the nurses, but for the sick; yet the service to the sick is being cut down to save a few paltry millions against a huge Budget.

The doctors can prescribe fewer drugs and items or patients can have fewer prescriptions. The hon. Member for Putney said that nothing should be done to interfere with doctors prescribing what patients need.

That is what this shilling will do, because the doctor now has to consider whether his patient can afford it. Therefore, an obstacle is being placed between doctor and patient. It does not affect the well-to-do patient. I feel very indignant about the whole business of charging for prescriptions. Almost from the year I was born, I was into a friendly society run by ordinary people and I do not think I ever paid for a prescription in my life. It has had to come now because of this silly budgetary idea of the Treasury that money must be saved in every Department.

If the doctor is to be able freely to prescribe what the patient needs, all charges must be abolished, unless we are to deter people from going for prescriptions. Do the Government want to deter patients from going to their doctors? The doctors tell us that that is the worst thing to do, because if patients do not
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go for the little things, they have to bear the cost of the big things and of the suffering that comes.

Before the Health Service was introduced most men had been covered for something like 50 years and it was the women and children who were penalised. Equally it is the women and children who are being penalised now more than the men. The women do not go for medical treatment because they want to save their families' budgets. We are returning to the circumstances of before the war, when women suffered in health because they saved their families' budgets by not spending enough upon their own health. Everybody here knows that, and everybody feels it on his conscience, for it was and it is wrong.

One hon. Member said this was a reflection on the doctors. My right hon. Friend the Member for Warrington cannot say what I am going to say. There is no doubt that there is a small minority of the doctors who have not behaved honourably by their profession in dealing with prescriptions. A doctor friend of mine went into a chemist's shop and the chemist showed him £5 worth of prescriptions on the counter which could have been got for 5s. When I was Secretary of State for Scotland a man brought me a roll of lint as long and as thick as my arm, and it had been prescribed for a cut finger. The B.M.A. could do nothing about it because it was very difficult to get anybody to come forward to give the evidence.

No doubt there are some doctors who have not been playing the game. They are doctors of the sort who have rich patients who read about some new or, at any rate, expensive cure used in America and want their doctors to prescribe it for them. They are patients who threaten their doctors. They threaten that if their doctors do not prescribe what they want they will go to other doctors. Something has to be done to protect the decent doctors who want to do decently by the National Health Service, and I hope the Minister will try to take steps to that end.

We are told we must not tell doctors what to prescribe, but every doctor gets a list of medicines which are the equivalents of the proprietary medicines for which huge prices are charged. I remember somebody gave me one of those
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prescriptions for a very elaborate medicine. I spoke to a doctor friend of mine, and he said "Listen, you can get the same good from a twopenny zinc ointment." That is the sort of waste that takes place. There is a vested interest in selling these expensive things, and the chemists share in it, because there is more profit to be made out of them than out of a twopenny package of boracic. I hope that is not why the hon. Member for Putney spoke in support of these new charges.

The Government are by this proposal raising the equivalent of £5 million of taxation in a year, and they are doing it through the sick alone. Whoever heard of any Chancellor of the Exchequer who could justify taxing the sick alone? I have never heard of it. It seems to me preposterous. What is the cost to the rest of us? It is a matter of a halfpenny a week. Do the Government mean to say the British public want to save a halfpenny a week at the expense of the sick, the maimed, the injured? My hon. Friend the Member for Kirkcaldy Burghs (Mr. Hubbard) has described them. This proposal is past understanding. I do not think anybody in this Chamber tonight really believes in it at all.

The Chancellor says, "Oh, but they can get the money back if they go through a means test." Has he really imagined what it means to ask these sick people to go through a means test? I have been X-rayed, and I felt very sorry for myself until I saw some of the other poor souls being X-rayed. Then I felt I was all right. How can the right hon. Gentleman suggest that those poor souls should go tramping about the streets or travelling in buses to get to the National Assistance Board when they are suffering in mind and body? There is nobody with any humanity at all who would ever suggest such a thing. I simply do not believe that the Minister of Health believes in this at all. I am sure he has nothing to do with it, but he has to defend the proposals of the Government to which he belongs.

What has staggered us in the last few weeks, and what I have not before seen in Parliament, is how so many hon. Members opposite out of party loyalty have stilled their own consciences on fundamental matters. I hope that tonight, at
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least, they will not still their consciences. I remember something Jimmy Maxton said in this House. He said he knew hon. Members opposite, and he knew that he could go to any one of them to get money to help anybody in difficulty. He said that individually they were the kindest people in the world, but collectively, in a matter of this kind, they seemed to develop a most curious mob psychology. At that time, he said, they were downing the waitresses. Now they are downing the sick. That is not what a great nation does. It is not what a great party should do. It is not what Members of Parliament should do. We are here to protect the weak and the maimed.

I say to every hon. Member opposite, "Do not still your consciences. Come into the Lobby with us if the Minister is not going to endorse this Prayer to Her Majesty to annul these Regulations." I ask the Minister to take upon himself the responsibility to go to the Chancellor and tell him to raise the money in some other way. The rest of us are quite willing to pay one-halfpenny a week in order that the sick shall not suffer more.

I ask the Minister to take upon himself the responsibility of withdrawing these Regulations and not to rise with a prepared speech to discuss all the pharmaceutical details and the piffling quibbles that we have heard tonight. This whole proposition is humbug, it is a piece of fraudulent budgetary imposition on the poor and the sick of the nation.

Hon. Members have put forward in the debate the real apprehensions of their constituents and I will try to deal with those apprehensions. There has also been in the debate, and I regret it, an attempt by some right hon. and hon. Members to make party capital out of this matter. I acquit the right hon. Lady the Member for Warrington (Dr. Summerskill). I thought the tone of her speech was quite unexceptionable, but the right hon. Member for East Stirlingshire (Mr. Woodburn) was forgetting a good deal of history when he was Secretary of State for Scotland and a good many of the problems.

I have tried, and I shall continue to try as long as I hold this office, to keep
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health out of party politics. [HON. MEMBERS: "The Chancellor did not."] However much hon. Members opposite jeer I shall go on trying. I intend to keep health out of party politics. There is no Conservative health, no Socialist health and no Liberal health. There is good health. Hon. Members can take with them what credit they like, but I have to administer this Health Service.

I have to see that there is no extravagance and that all the Service is administered properly. That is the problem, and that is why, in the present financial emergency, I have to see whether there can be any increased contribution from the Health Service or any saving on expenditure.

I have looked round the whole of the branches of the Service. We are constantly trying to avoid wasteful expenditure, and I am quite certain that there is no possible way of reducing expenditure, without closing beds or reducing service, except the present alteration of the prescription charge.

Right hon. and hon. Members opposite have been most courteous to me and have said through the debate, "This is not the decision of the Minister of Health." But I believe that this is the right decision in order to raise this money. Why have we chosen to raise this £5 million, the alteration in the charge?
It is because our experience has gone to show that it was this very vital pant of the Service in which the general practitioner was most involved and where the greatest load had fallen, and that the Service was inclined in some respect not to give the standard of service we wanted from it."—[OFFICIAL REPORT, 9th December, 1949; Vol. 470. c. 2260.]
Those words were used by the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) in December, 1949, to justify this very charge.

It is sometimes forgotten in debate that this is a problem which has faced successive Ministers. I am not blaming the right hon. Gentleman that at that time he and his Government came to that decision. In October, 1949, when Lord Attlee was Prime Minister, he
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announced that £10 million would be obtained from charges when in England and Wales the cost per item was 3s., the total drug bill was £30 million, and the total cost of the National Health Service falling on the Exchequer was £340 million. What are the facts today?

What were the facts two years later, in 1951? Did I not say then, standing at the Box opposite, that
… the charge would inevitably fall, whatever exemptions were made, repeatedly and regularly on the chronic sick and ailing"?—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 239.]
That is why, after two years' reflection, we did not levy this charge.

I cannot give way. I did not interrupt, though I was greatly tempted. I have sat on this bench all the evening without interrupting, knowing there was very little time for the debate, and that interruptions would spoil it.

The facts are that in 1949 there were 200 million items. The estimated income from the charge announced by Lord Attlee in the House of Commons was £10 million, and if hon. Gentlemen opposite can tell me how we can get £10 million out of 200 million items except by charging 1s. an item, then I will stand corrected.

What is the position today? My estimate this year was for a cost per item of 4s. 6d. The total drug bill will be found in my estimate as £53 million. I must tell the House that today it appears that the cost per item will be, on an average, 5s. The total drug bill will be £61 million, and the total National Health Service bill falling on the Exchequer will be £475 million.

I was very grateful to the right hon. Lady for that part of her speech dealing with the cost of the pharmaceutical service, and I entirely agree with her that the growing increase in that cost is a most serious problem. Successive Governments have failed to find a solution to it. I also agree with her that a large part of the additional cost is due to the
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new and comparatively expensive drugs which have been developed and made available for treatment in recent years.

No one would wish to deprive patients of treatment with those drugs. Many of them are of great value—[An HON. MEMBER: "Not all."]—for treating conditions which previously could not be treated and for restoring patients to health. The difficulty is that these new treatments have to be paid for. The medical profession, and expert advisory committees which have reported on the question, take the view that there should be no interference with the right of a doctor to prescribe whatever he considers necessary.

I accept that principle. That was the main difficulty that I found in listening to the right hon. Lady's speech on that point. I must not interfere with the doctor's right to prescribe, but I can assure the House that I am actively considering ways in which we can reduce the cost. Already, we provide doctors with the National Formulary and with the small brochure which the right hon. Lady produced, the "Preservers' Notes," which draw attention to the published reports on treatment, the prices of preparations and other matters which will help doctors to prescribe effectively and with economy.

I believe that we must do more. I am sure that we must educate the young doctor so that he knows more about economical prescribing. I believe that we have also to go into the question—here I entirely agree with the right hon. Lady—of the pressure of the salesmanship of the drug houses and the other pressures to which a doctor is subjected. I shall give early consideration to further ways of dealing with that part of the problem.

On the pharmaceutical side, with the co-operation of the pharmaceutical manufacturers we have made inquiries into the prices of standard and proprietary drugs. The general level of prices of standard drugs was not considered to call for intervention by the Department, but I am continuing discussions at present on the prices of proprietary preparations. Discussions are also proceeding with the chemists about an inquiry into the prices paid by them for standard drugs as compared with the prices fixed by the Drug
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Tariff. The chemists have now agreed to co-operate in such an inquiry in the spring. Meanwhile, we have to face the increased cost this year and next year, for I anticipate that next year there will be a drug bill of about £64 million.

I have turned to a charge of 1s. an item instead of 1s. a form for the following reason. When Lord Crookshank introduced the charge in 1952 as 1s. a form, the effect was very considerably to increase the number of items put on each form. In this connection, my hon. Friend the Member for Clitheroe (Mr. Fort) has referred to para. 588 of
the Guillebaud Report. It was a very considerable increase. It is true, as my hon. Friend the Member for Wythenshawe (Mrs. Hill) said, that in the handbook doctors are asked to put only two items on the form. A recent survey that we made showed that five-sixths of the forms had one or two items each, while one-sixth, probably more than 20 million forms, had more than two items and some as many as eight or nine.

That is the point on which I disagree with hon. Members opposite. Among the patients involved are what are called "shopping list patients", whose doctors are being induced to stock up the patients' medicine cupboards. [HON. MEMBERS: "Who induced them?"] I have listened to the debate without interrupting. Hon. Members doubt that fact, but the right hon. Member for East Stirlingshire himself underlined it. How can they deny that?

What I want hon. Members to realise is that the present system, as at present operated, is creating gross inequality. On the one hand are doctors who abide by the request in the handbook that there should be only two items on the form, and the patients are paying 1s. every time they have a prescription. On the other hand, where what one might call the weaker doctors put a large number of items on a form, there are patients getting a large number of items for only 1s.

That is not the position. I want hon. Members to think of two different patients suffering from the same remedy—[Laughter.]; I had better retract that now in view of what the British Medical Association may say tomorrow—I mean, suffering from the same illness and requiring the same remedy. One goes to a doctor who abides by the handbook and who cuts down the items to two on the form and gives the patient three forms so that the patient has to pay 3s. Another patient goes to a doctor who puts all six items on one form as a result of which his patient has to pay only 1s.

Which is the more deserving patient? There is that inequality and there is another inequality in the system. There are very many patients—[An HON. MEMBER: "Call in a psychiatrist."]—who are most deserving. There are many patients who are on a one-item prescription which
continually requires to be renewed and who cannot be given doses to last a long time. Which are they?

Among patients in that category are many suffering from the following chronic illnesses: high blood pressure, pernicious anaemia, insomnia, and some of the cardiac conditions. In some of these cases the patients have their prescriptions weekly or fortnightly and pay 52s. or 26s. in the course of the year. Compared with what others pay, that is a very large sum in the year.

It would clearly be quite wrong that those people should pay any more, and they will in fact not have to pay a penny more on their prescriptions. According to my survey, on half the prescriptions today there will not be one penny increase and it is my contention that the vast majority of the cases about whom the hon. Member for Kirkcaldy Burghs (Mr. Hubbard)
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was talking will not have to pay the increase, because they are now on one-item prescriptions—[An HON. MEMBER: "The chronic sick?"]—the chronic sick.

Hon. Members mentioned other illnesses and I want to deal in particular with those. First, I would mention the diabetics. During the course of a year the diabetic will require insulin, a syringe, spare needles, cotton wool, surgical spirit and a reagent. There are two types of insulin, but under the Regulations both types come within the 1s. prescription charge. If the diabetic condition is stabilised all these can be prescribed at two-or three-monthly intervals. At present, if all the items are put on the same form, as compared with the 52s. or the 26s. which the chronic cardiac case pays, the diabetic pays 6s. or 4s. Under the Regulations he will pay 27s. or 17s. a year. That is still a good deal less than will be paid by the chronic cases that I have mentioned.

Hon. Members opposite mentioned the colostomy cases. I agree that they are very difficult. They require monthly or two-monthly supplies of cellulose wadding, cotton wool and plastic bags, and the replacement of appliances. At present, the colostomy case pays either 12s. or 6s. a year in 1s. prescription forms. Under the system which I am introducing in
these Regulations he will pay 36s. or 18s. a year. He is the most difficult of the chronic sick cases, but even under the Regulations he will be paying less than the chronic cardiac who is now paying 52s. a year.

The cost of the pharmaceutical service has doubled since 1949. As my hon. Friend the Member for Wythenshawe (Mrs. Hill) said, except for the 10d. per week for a man, the 8d. per week for a woman and the 6d. per week for a boy or girl, which come from the National Insurance system—which represents only £36 million in a year—and the £28 million from superannuation, the remaining £500 million has to come from the Exchequer and from charges. At this time of financial emergency this extra £5 million has to be found, and I believe that it can be found better by this means than by any other.

I now turn to the question of hardship. If I hold the view which I have just put forward I must see to it that this system
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is brought in with the least hardship to the most deserving cases. I entirely agree with what hon. Members on both sides of the House have said—that is it is the low, fixed-income group which must be specially considered. First, I have made it possible in the Regulations for medicine or tablets to be put into two or three containers, and be subject only to the charge of 1s. That will mean that, if he so decides, a doctor may prescribe for a considerable period ahead. This will enable doctors in, for example, diabetic cases to prescribe for a three-monthly period.

It has been suggested by the right hon. Lady opposite that this is an encouragement to over-prescribing. I think that is a misunderstanding of the problem. Under this system the amount prescribed per year per patient will be no more than if the prescribing were done over a shorter interval. I am here dealing with the chronically-ill patients. They are the ones I want to help and by this method of prescribing over a longer period they will not be paying any more.

Over-prescribing is where a doctor prescribes more expensively than is necessary for the proper treatment of the patient. This is a matter that is determined by the local medical committees. In fact, by taking away the inducement to add unnecessary items to the same form, over-prescribing is being actively discouraged.

Is the Minister not aware that the dosage of insulin for diabetic cases varies from week to week, that one cannot prescribe for a lengthy period? The same thing applies all the way through these illnesses.

I was dealing with the case of the diabetic whose condition is stabilised. The hon. Gentleman is perfectly right if the condition is not stabililised. Then, of course, it is different.

I am providing in the Regulations for certain composite packs to be charged at 1s. Examples of these packs are the syringe and spare needles for diabetics, the vaporiser set for bronchitis patients and the multiple pack dressings for minor wounds. The conditions governing the creation of multiple packs are that the articles must be frequently prescribed at the same time and sufficiently often prescribed to make it worth while for the manufacturers to make up the
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packs. Those are the steps that I have taken. I have asked the British Medical Association whether it can suggest any further multiple packs, and if any are suggested I will at once approach the manufacturers.

The normal way of relieving hardship is through the National Assistance Board. [HON. MEMBERS: "Oh."] I am surprised at hon. Members doubting that because it was made absolutely clear when I was a back bencher and when the right hon. Lady opposite was Minister of Pensions and National Insurance. When we were dealing with similar questions of hardship we were always told that National Assistance was the normal way of dealing with such cases.

I do not think that the right hon. Gentleman has compared what he is doing now with what I did. Never in my life would I allow myself to stand at the Dispatch Box and argue the case for taxing colostomies who have an expectation of life of perhaps a year or two.

I thought that hon. Members wanted to take part in the debate. If they interrupt it will take longer. If they do not wish to listen to me there is a very easy remedy; they can always go out.

Last year, over 9 million prescription charges were refunded. The method has worked very smoothly since 1952, but I have now made arrangements for improving the machinery of National Assistance. With the co-operation of the National Assistance Board, the Postmaster-General and the Minister of Labour and National Service, the following alterations are being made. First, from 1st December persons receiving National Assistance will be able to take their receipts straight from the chemist's shop to the Post Office.

Then they would not be in the chemist's shop. In that event, whoever goes to the chemist's shop would do it. This will mean that they will not have to wait. They can go at once, and need pot wait until the day when their National Assistance grant, their unemployment
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assistance or their supplementary pension is normally paid. They will avoid the delay which has sometimes proved irksome.

The right hon. Lady the Member for Warrington had some critical remarks to make about the notices we put up in the chemists' shops. They were a reproduction of the ones previously used, with very slight alterations. That is why elastic hosiery had so many mentions. In fact, there is no alteration at all in the charge for elastic hosiery.

The alteration I have made, with the help of the Chairman of the National Assistance Board, is that in the chemists' shops there will be a small new leaflet which will have on it a place for the name and address of the person who wishes to apply to get a refund. That can be taken straight away and put in the post box and it will go to the National Assistance Office. That will mean that the person will not have to travel to the office. I emphasise that. A visit will be paid from the National Assistance office. Nobody will have to go to the National Assistance office.

The person on National Assistance will go direct to the post office. He will hand in his receipt and get the money. In the other case, there has first to be an inquiry and then the money will be paid at the post office.

I do not want to embarrass the right hon. Gentleman but I should like to understand what he means. May I take it that where an applicant posts his application the Assistance Board will send direct to him? The right hon. Gentleman said that there would be an inquiry. Does he mean that
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a visitor will have to go and inquire first, and then make his report back to the Board?

I am dealing first with somebody who is already on National Assistance. He will go to the post office and get the money. If somebody is not on National Assistance and wants to claim a refund he will post the leaflet to the National Assistance office, and the National Assistance officer will visit him and talk to him in his own home so as to save him from having to travel.

The third improvement affects the case where somebody is on a margin and where the charges will bring him just below the scale. In all cases the refund will be the whole amount of the receipt from the chemist.

I do not know whether the right hon. Gentleman is fully aware of what he is suggesting. He has already agreed with me about this. When I made my speech he nodded when I told him of the analysis of these cases and how the worst were the diabetics, epileptics, and those suffering from such things as heart disease, anaemia, and ulcers. Is he suggesting that these chronic patients can write to the Assistance Board and that an official from the Board will visit them to discuss whether they are able to pay?

That is why we have done this in the form of a leaflet. All that has 'to be done is to put the name and address and send the form to the National Assistance Board, and the Board will then make inquiries. If it is an obvious case of hardship such as the right hon. Lady suggests, there will be immediate payment.

This is an important matter. We know exactly the position of people on National Assistance, but the Minister knows full well, or ought to know, how long it takes for these visits to be made. Some of us who live in back-streets know that it takes the National Assistant Board's officers all their time to visit the applicants for National Assistance once every three or four months.
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The officers will get hundreds of additional cases which are above the National Assistance Board's scale where application is being made for prescription refund. He will need many more National Assistance Board officers to visit these homes.

I think I have given way enough on that subject. I will continue to watch most closely this question of hardship both for those in the fixed income group and for those on National Assistance. Right hon. and hon. Members opposite do not agree with me about this charge. We may have different views about how it will work out. But I want hon. Members on all sides to give me assistance and advice in trying to remove the difficulties and hardship.

I believe that as a result of the suggestions which I have made, for instance about the longer prescribing, there will not be the results which hon. Members fear. Let hon. Members co-operate by writing to me if any cases of hardship are found which are not dealt with under the Regulations
or by the National Assistance Board. After a time has elapsed, I want to hear about cases of constituents which right hon. and hon. Members find.

Some of my hon. Friends who have spoken in the debate have referred to what I regard as hard cases—those who will pay more than the chronic cardiac about whom I spoke and who is now paying 52s. a year. I believe that much of this feeling that many people will suffer hardship overlooks one fact. It is true that people will be getting a prescription sometimes costing 5s. or 6s., but it will last them a considerable time. If hon. Members find cases in which people pay more than 50s. or 60s. in the year, I hope that they will write to me and give me examples of those cases.

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Let us look at the matter in its proper perspective. The full burden of the charge on the pharmaceutical service after 1st December will be about 1¼d. per person per week in this country. At present, it is about ¾d. per person per week. When he was dealing with a similar proposal in 1949, the right hon. Member for Ebbw Vale said:
Let us look at the actual facts. It is not the National Health Service /that would be making a charge to the patient. It is the National Health Service that would be saying to the patient: 'Where a doctor has given you a prescription that costs more than a shilling, National Health Service will pay the cost above a shilling, but up to the shilling you will pay'."—[OFFICIAL REPORT, 9th December. 1949; Vol. 470, c. 2261.]
I do not quarrel with the right hon. Gentleman's presentation of the case. There is another way of putting it—and I put this to the House. This charge is, in fact, less than the average dispensing fee in respect of each item. The drug or the appliance is, therefore, absolutely free to the patient—[HON. MEMBERS: "Oh."] Perhaps hon. Gentlemen prefer the explanation of the right hon. Gentleman the Member for Ebbw Vale. I was quoting from HANSARD. I think that now, in

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a time of grave economic difficulty, we can take comfort in the fact that we are asking patients to pay only the cost of dispensing, and that they are receiving the drugs and appliances free from the Service. No other Health Service in the world gives better service. I believe that hon. Members on all side take pride in that fact, and wish to help me to improve that Service.

Does not the Minister's speech, and all the speeches that have come from that side of the House, start from the assumption that this will cause great hardship; and has he not joined all his other hon. Friends in trying to use all sorts of different quibbles by which he can avoid the hardship that the charge will cause? Would it not have been simpler not to have had the charge to start with?